Provider Demographics
NPI:1790972495
Name:ESPEJO, MARIA MAGNOLIA SORIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA MAGNOLIA
Middle Name:SORIANO
Last Name:ESPEJO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1303 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MOUND CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64470-1717
Mailing Address - Country:US
Mailing Address - Phone:660-442-5464
Mailing Address - Fax:660-442-5927
Practice Address - Street 1:1303 STATE ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:MO
Practice Address - Zip Code:64470-1717
Practice Address - Country:US
Practice Address - Phone:660-442-5464
Practice Address - Fax:660-442-5927
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2008035883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1405261053OtherBNDD
MO1790972495Medicaid
MO1790972495Medicaid
FE1222520OtherDEA